This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.

Friday, October 06, 2006

Have you read the Globe today?

Christopher Rowland, a reporter at the Boston Globe, has a story about my blog in today's paper. We had a nice talk about it a few days ago. Mr. Rowland, while an excellent reporter, left out a key quote as to why I started the blog: "It was to have a dialog with people about issues of importance without the interference of reporters and editors." :)

Seriously, I like the story . . . and, more importantly, I really do appreciate the difficulty for reporters and editors in making sense of complicated issues in health care. Isn't it interesting, though, that this blogging topic is newsworthy enough to be put in the newspaper? For hundreds of thousands of people, a blog is just a blog and no big deal, but as noted when I started this experiment, among CEOs it remains rare. Thanks to the Globe for printing the story. Maybe some of my colleagues will join in with their own blog, or at least reply to some of my postings: Hey guys and gals, you can do that anonymously, so you can say all those things you REALLY want to say, but where you don't want attribution . . . . :)

If you are just joining this site as a result of Mr. Rowland's story, please read on and write back.

25 comments:

Anonymous
said...

Dear Mr. Levy,

I did read the article this morning in the Globe or I wouldn't have been aware of your blog. I was struck while I read it (at 6:01 am) that while, yes, blogging is good for PR but more importantly gives the public a vehicle to view people such as yourself as a "real person". In this era, I think it's important to see the basics rather than the personna. I have enjoyed reading your blog and will be a visitor! I am a Certified Medical Coder so let me know if you have any good management opportunities. Have a great day and a safe Columbus Day Weekend.

Thanks, Stephanie. We are always looking for good people. Please submit your resume through our website www.bidmc.harvard.edu under "Careers", or, if you want, send me a snail mail cover letter with your interests, and I will forward it to the right folks.

I don't have any reason to believe that Tufts Dental has a more serious issue with this than anyone else, but I suggest you work with that organization to get answers to your particular questions. Ordinarily, I am not sure I would permit a posting of this kind of comment about someone else's institution, except that the link you provide leads to a discussion about the problem of methicillin-resistant staphylococcus aureus (MRSA), which is an important infection problems faced by hospitals around the world. One of the world's experts on this bug is Dr. Robert Moellering, former chief of medicine at BIDMC, who is still on our staff and who provides advice to colleagues worldwide on this topic.

Dear Mr. Levy,I read the Globe article and was so pleased to find a place to make a few comments. My daughter, who is 17, has been suffering from a bone marrow disorder. For the past four months, we have waded through the thicket of Boston's medical community, seeing one expert after another, with little or no guidance. It often took weeks to schedule the right tests and more weeks to see the specialists, none of which corrdinated with each other and most of whom offered differing opinions. Desperate, we took our daughter to The Mayo Clinic in Minnesota. While the doctors there did not render a clearer diagnosis, the process we experienced was by far more consumer centric. I hope you will take a look at The Mayo Model when you consider how to configure your hospital expansion. When my daughter is all better, I will write a book on our experience and will send you the first copy. Thanks for your blog site.

I think it's fantastic that you're doing this blog. Healthcare is so complicated to the average patient, it's nice to get some insight. I'm wondering if you could address another aspect of the transparency issue: while it would be great to know what hospitals charge for procedures, as a patient/consumer, what I'm really interested in is "how much will I pay?" In many cases, the patient doesn't realize that an expensive procedure will not be covered by insurance, and is hit with a nasty surprise months later. When a referral is made, or a procedure is ordered, there should be some easy way for a patient to know if a doctor is out-of-network, or if their emergency surgery will be covered. Trying to fix it later through appeals can be a months or years-long nightmare. I don't want to make it the doctors' responsibility to understand the thousands of insurance plans in MA, but it seems there has to be a better way than the current method, where the patient is basically blind.

I saw the article today in the Globe and was delighted to find that you have a blog. Your insights may prove to be significant in the ever evolving, complex world in which you operate (no pun intended).

One area that I find fascinating is the different reimbursement rates that networks are able to negotiate with insurers. Why should Partners get better reimbursements than BIDMC? Should there be a major overhaul to the process, perhaps, to be based upon performance, efficiencies, and other key factors, not size? Otherwise, we could go down the path of rate setting by the Commonwealth, much like auto insureance, and 'drive' the health insurers right out of the state.

I have always admired your leadership since I was a student, and temporary employee at Harvard Medical School some time ago.(I worked in the Human Resources Department as a temp, as well as in the Countway Library)

We had a short conversation that made a distinct impact on my current career choice, and you are probably not even aware of it!

Anyway, I find your blog to be very interesting. I was glad to see the article about it in the paper, or I never would have heard about it at all!

I just read about this blog in the globe and I think it's a great idea. I write for another blog and we often write about healthcare facing women and queer folks and are excited to start following your blog.

Thanks, Keith, for letting us know. I hope people check out your site. People are discussing lots of different ways to post quality results. While anecdotes and stories are always interesting, they can give the impression of being representative. The trick is to post actual outcomes data in a way that is accurate, reflective of the different risk levels that patients show, and also up-to-date. See the next posting on this topic.

On Nishla's point, this is an issue that often arises. The obvious answer is to have information systems that immediately and in real time, tell the patient and doctor what is or is not covered by the insurance company. Lots of people are working on that, us included. There is actually a consortium of hospitals and insurance companies called the MA Health Data Consortium that is working on those issues. Check them out at http://www.mahealthdata.org/.

In the meantime, we have just completed work on part of the problem. Our Chief Information Officer, John Halamka, and his staff and the major pharmacy chains in the state have concluded work on an electronic prescription system that eliminate scrips. Your doctor has a pull-down menu on a website to find the drug you need and the name of your local pharmacy, and there is an immediate message as to whether your insurance company covers that drug or requires an alternate generic version, and sends the information instantaneously to your pharmacy. We are just rolling this out in our primary care practices, and it will soon be available to doctors throughout the state.

Did you read a post on Google today on the use of religion for organizations to discriminate against employees under the separatuib if church and state?A must read to discuss the issue of unions for employees of any facility related, however remotely, to an organizied religion. It is used to discriminate in multiple ways.I am new to this blog having just read of it in Friday's Globe.Having been in the health care field for >40 years the health care field has become a "medical industrial complex" with money to the shareholders, administers and the wealthier providers (MD's,pharmiaceuticals, durable and disposable equipment and supplies, etc)and to the loss of benefit to the patient who is the one "all" about whom talk such a good talk. However, it is the patient who is left with the mistreatment, expense, pain and suffering from the need of those higher in the hierarchy.My father owned his own business (medium size) during the depression and into the 60's and was very proud non ever unionized. He treated the people working for him well as he realized that if he treated them well, they would take care of business well. Unions only form when there are grave injustices occuring within an employment center.Who's inequity are you referring to?

It takes guts to have a blog and something even rarer than that to question your own position in a public forum like this one. I guess the Irish would call it moxie.

As for the Jewish issue that your friend raised in connection with how to treat the SEIU, I think I understood what he meant.

So many Jews, my own close relatives included, helped found America's labor movement. The Jewish clergy for that matter were also very closely aligned with the Civil Rights Movement in the Martin King era. So we have a history, at least, in the last century as one of the other bloggers suggested, of standing up for oppressed peoples. This sympathy is due, in no small part to the fact that we ourselves had been oppressed for more than 2000 years.

Setting aside all of the other issues that have been raised about how the SEIU is approaching the hospital and whether there is something remiss in their tactics, the key to understanding may be to look at the membership of that organization. A good number of them, in the thousands, are janitors without healthcare.

Basically, they are working poor people who don't have healthcare. Standing back, it makes a certain amount of sense for the SEIU to try and make an example of your teaching hospital by connecting you to their issue, namely lack of healthcare.

As a Jew, as a religious anything really, it's hard not to find sympathy for the working poor who can't get a fair shake. At the end of the day, I'm not sure all the issues have been clearly defined; it appears that there are some red herrings that are clouding the debate. Your friend saw past those.

I do understand the historical context, but I guess I have trouble "setting aside all the other issues" about union organizing tactics. One of the commenters under my posting "Union Issues" raised this point: If a union's tactics are inherently undemocratic, how can you have faith that they truly have the best interests of the workers in mind? At best, doesn't that reflect a paternalistic view of the world on the part of those union leaders? At worst, doesn't it indicate a desire to gain political and economic power at the cost of individual rights?

Yes - I read about your blog in Globe - and thanks for sharing insights on what often seems like a black hole - how tough decisions are made in a hospital. I remember you from your energy days. Keep up the good work. JJA

I have been enjoying your blog since a colleague of mine who knows you from your energy days passed it along to me a few weeks ago. If you are looking for possible topics to discuss, I would be very interested in hearing your perspective on how Massachusetts' new required health insurance coverage for the low income will affect BIDMC, and what you think its implications are for the state more broadly.

Thanks for your leadership in showing BIDMC (and yourself) to the world.

Thanks. I am not sure I have much to offer on the new legislation. There are other more knowledgeable observers. For example, check out the Health Care for All link above.

As for BIDMC, the main result should be that we would see fewer free care patients, in that many of those people will instead be insured under the new law. But, until it has been working for a while, it is hard to predict very much.

I came across your blog by accident and therefore a comment on one of your earlier posts.

Kudos to you for starting this blog. It always amazes me how behind-the- curve we in the healthcare profession in comparison to our tech industry counterparts. Free flowing exchange of ideas in this kind of a forum etc. is not "cool" its almost necessary today - the healthcare being one of the oldest orgainzed industries in world tends to have a little more inertia to adopt.

As far as I am concerned, I work in healthcare private equity in New York with a special emphasis on investing in emerging economies such as India etc. From that perspective, your thoughts and experiences are invaluable. Please keep up the good work...AP